For cases of foraminal and extraforaminal monophasic synovial sarcoma post excision with note of residual tumor, would your approach be a second look surgery with re-excision or delivery of adjuvant RT with boost to residual disease?
Would you consider doing a pre-op RT prior to possible re-excision? If yes, what dose would you give? If the location is between L4-L5 spine.
Answer from: Radiation Oncologist at Academic Institution
Great (and tough!) question. In the setting of residual disease post-surgery, many studies have shown that even with adjuvant radiation therapy, leaving gross disease behind leads to inferior outcomes.
In the setting on non-oncologically excised tumors, I would first have a discussion with th...
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Answer from: Medical Oncologist at Academic Institution
Adjuvant chemotherapy could benefit sarcoma patients with R1 resections. First: 2 things as regards high-grade sarcoma and positive margins. 1. Talk to the surgeon. If the R1 resection was because the surgeon was caught by surprise by the nature or location of the tumor (for example the tu...